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COMMENTS ON PUBLISHED ARTICLE
Year : 2020  |  Volume : 64  |  Issue : 9  |  Page : 827  

A comment on “Indian Resuscitation Council suggested guidelines for Comprehensive Cardiopulmonary Life Support for suspected or confirmed coronavirus disease patient”


Department of Anesthesiology, Amala Institute of Medical Sciences, Thrissur, Kerala, India

Date of Submission23-Jun-2020
Date of Decision24-Jun-2020
Date of Acceptance25-Jun-2020
Date of Web Publication01-Sep-2020

Correspondence Address:
Dr. Paul O Raphael
Amala Institute of Medical Sciences, Thrissur - 680 555, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ija.IJA_828_20

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How to cite this article:
Raphael PO. A comment on “Indian Resuscitation Council suggested guidelines for Comprehensive Cardiopulmonary Life Support for suspected or confirmed coronavirus disease patient”. Indian J Anaesth 2020;64:827

How to cite this URL:
Raphael PO. A comment on “Indian Resuscitation Council suggested guidelines for Comprehensive Cardiopulmonary Life Support for suspected or confirmed coronavirus disease patient”. Indian J Anaesth [serial online] 2020 [cited 2020 Sep 22];64:827. Available from: http://www.ijaweb.org/text.asp?2020/64/9/827/294082



Sir,

I read with great interest the special article by Singh et al.[1] on comprehensive cardiopulmonary life support for suspected or confirmed coronavirus disease (COVID-19) patient. Patients with COVID-19-related acute respiratory distress syndrome are ventilated prone for as long as 12 to 16 h per day. We can expect more cardiac arrest scenarios during prone position than during supine in ventilated COVID-19 patients. In the event of a cardiac arrest, authors have suggested changing the position to supine before initiating cardiopulmonary resuscitation (CPR). Utmost care should be taken to avoid ventilator disconnections during the change of position and the sufficient number of personnel should be available during turning. This could lead to unnecessary delay in the initiation of CPR and thus decreases the survival rate of the patient. The equipment disconnection and aerosolisation adds to the risk of exposure in health care workers involved in resuscitation.

American Heart Association (AHA) in collaboration with the various association of clinicians, in its interim guidance on cardiac arrest with suspected or confirmed COVID-19 describes the CPR in prone position even though the effectiveness of CPR in the prone position is not completely known.[2] Those patients who are in the prone position with an advanced airway, avoid turning the patient to the supine position unless able to do so without risk of equipment disconnections and aerosolisation. The CPR is provided with the patient remaining prone with hands in the standard position over the T7/T10 vertebral bodies.[3] The AHA interim guidance committee statement also mentions, consider placing defibrillator pads in the anterior-posterior position. I would like to suggest CPR in the prone position for COVID-19 patients who are mechanically ventilated to avoid delay in initiation of CPR and disconnection of the endotracheal tube.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Singh B, Garg R, Chakra Rao SSC, Ahmed SM, Divatia JV, Ramakrishnan TV, et al. Indian resuscitation council (IRC) suggested guidelines for comprehensive cardiopulmonary life support (CCLS) for suspected or confirmed coronavirus disease (COVID-19) patient. Indian J Anaesth 2020;64:14;91-6.  Back to cited text no. 1
    
2.
Edelson DP, Sasson C, Chan PS, Atkins DL, Aziz K, Becker LB, et al. Interim guidance for basic and advanced life support in adults, children, and neonates with suspected or confirmed COVID-19. Circulation 2020;141:e933-43.  Back to cited text no. 2
    
3.
Miazer SP, Weistfeldt M, Bai D, Caedinale C, Arora R, Ma C, et al. Reverse CPR: A pilot study of CPR in the prone position. Resuscitation 2003;57:279-85.  Back to cited text no. 3
    




 

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